The Dawn of Superbugs and Demise of Antibiotics

Read this article to know about the causes and the ways of controlling antibiotic resistance among the microbes.

Introduction

antibiotic resistance

Antibiotic Resistance in the Superbugs

A stealthy killer which appears to have no antidote

-by Zeeshan Ali

Nine year old Nisha has stopped responding to her antibiotics. Due to the resistance that her body has developed against the frontline drugs, in her 2 year battle with Tuberculosis, she is losing.

Her parents are daily wage earners and her medication gets abruptly discontinued due myriad reasons and her initial 6month program has become torturously unending.

But she is not the only one. According to revised estimates by the World Health Organisation (2015), India has 3.6 million people battling with Tuberculosis and almost 70,000 of patients harbouring TB that is immune to at least four types of drugs, and as many as 15,000 may have an even more dangerous type called “extensively drug-resistant” TB or XDR-TB that fights off almost every antibiotic in the medical arsenal.

Emergence of Drug Resistance

Drug resistance was first witnessed as the fallout of HIV infection which renders a patient immunologically vulnerable to infectious diseases like TB.

Navjeet(24), who is a resident of Jammu but works in a Gurgaon-based MNC says,”I took Penicillin as a child for Rheumatic Fever and several antibiotics like Azithromycin afterwards. Resultantly, over the years my body has stopped showing any response to them.”

The fight against drug resistant TB in India was brought to the fore by a Mumbai pulmonologist, Dr Zarir Udwadia, after diagnosing four totally drug resistant TB patients.  India, having the highest incidence of TB in the world, needs a wake up call.

Throughout human history, pandemic bacterial diseases such as TB and the plague have threatened human health and survival. Antibiotics ushered an age of powerful repertoire against bacterial infections.

However, through mutation and horizontal gene transfer, bacteria are evolving into more resilient forms in order to ward off antibiotics and proving to be the scourge of our times.   

To start with, ARGs (Antibiotic resistance genes) were naturally developed by microbes in order to eliminate competition from other microbes. These are now easily morphing battlefields from fighting helminthes and fungus in the soil to conquering our manufactured drugs.

Antibiotic resistance develops over time — beginning with a very small number of microbes within a population that possess genes having resistance to drugs and some with ability to withstand treatments and then they exchange genes with each other, developing incredible resilience.

This intermingling of sturdy, difficult to treat hospital bugs with environmental bugs provides a fertile ground for superbugs.

Identified as ‘Superbugs‘ like Mycobacterium tuberculae (Drug resistant TB), Klebsiella pneumoniae (Pneumonia) and Methicillin-resistant Staphylococcus aureus(Staph) these microbes are found across environmental habitats.

Developing Strategies to Minimise the Antibiotic Resistance

Understanding the sources of antibiotic resistance, and how it spreads through bacterial populations, is critical for developing effective strategies to combat resistance and minimize its threat.

There are places where pathogens and non-pathogens (harboring resistance genes) commingle. One potential source is livestock, where animals are loaded up with high doses of antibiotics in their feeds even when they are not sick and it finds a way into our food chain, in much the same way like fertilizers and urea do on fruits and vegetables. But agricultural misuse isn’t the only explanation.

The journal of the International Society for Microbial Ecology (ISME) in its 2014 issue highlighted the role of “Wastewater as a point source of antibiotic-resistance genes in the sediment of a freshwater lake”. So industrial effluent is also a possible source.

According to Mr. Vijay (name changed) who is a pharmacist and plies his trade in Malviya Nagar area of the capital, chemists go along with the prescribed drugs and quantities even with the knowledge about the predatory nature of the prescription, to ensure their commission and survival in the market.

Our country lacks uniform guidelines for the use of antibiotics, resistance tracking and surveillance. Together with unscrupulous antibiotics use by doctors, chemists and even quacks, they form a menacing trifecta which is changing our innate immunity.

”Extremely easy, over the counter availability of antibiotics is a threat and needs to be nipped in the bud,” says Dr Suhail Qureshi, currently attached to BLK super specialty hospital in New Delhi.

“You can go to any chemist shop and buy any antibiotic (tablet or injection) without any prescription. Common cold and loose motions are two of the most common ailments which are self limiting and usually do not require antibiotics and none should be prescribed. But the practice is rampant,” he adds.

“Paucity of diagnostic laboratories or testing infrastructure, poorly-trained health practitioners and thousands of infected people living in over-crowded and unsanitary conditions has made India home to the world’s largest epidemic of drug-resistant TB.  Discontinuous or interrupted treatment of diseases like TB is leading to the creation of highly sturdy, lethal and life threatening species of micro organisms which are multi drug resistant,” he adds.

Overuse of frontline antibiotics is the classic recipe for developing resistance.

Still adding to the bleak picture are the recent findings that contradict the prevailing view that bacteria become less “fit” when they acquire resistance to drugs. A new study suggests they survive better in the host and are deadlier.

The age of newer antibiotic development is slowing down. Growth of newer bugs has fast outpaced antibiotic development. It necessitates time, lots of money, research, technical expertise, patience and government support to develop an antibiotic, and then test it in clinical trials before its final approval.

The cost becomes unaffordable and often prohibitive in the process and patents by manufacturing companies to extract their cost of research over the drugs takes many years before other companies can make generic or cheaper versions of the same.

By that time, the bugs mutate and develop resistance to this new drug as well.

But there are few rays of optimism. In 2015 FDA approved  two new drugs,  Bedaquiline’ and ‘Delamanid’.  Bedaquiline, a drug rolled out in India last year and dubbed as ‘the miracle drug’, has shown potential to cure even  the most resistant of TB cases.

The use of natural agents like Viruses is also at the stage of clinical trials. ‘Bacteriophages’ are viruses that infect bacteria and are allies in war with bacteria. However, they can spread the resistant genes themselves as they are essentially little capsules that carry DNA from one bacterium to another.

It is a very complex issue and requires multi agency involvement across nations and well devised multi-pronged strategy. Yet again, implementation and strict adherence is far more important than just legislations.

On an individual level people must see their prescribed courses to its completion and prevent their use by someone else. Healthcare professionals and pharmacists need to show more responsibility while handing out the drugs. These drugs must be encouraged as a last resort.

A boost to drug research and development programme also puts the onus on the policymakers to help establish a fostering ecosystem for healthy living and appropriate drug use. Bringing private healthcare providers in consonance is imperative too, as they are the first point-of-contact in many cases.

-by Zeeshan Ali

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